Feds to expand access to opioid treatment

The federal government will move to increase access to medication-assisted treatment for opioid dependence by relaxing  limits on prescribing buprenorphine, one of the few – and vastly under-used – evidence-based treatments for a disorder that has reached epidemic proportions.

Health and Human Services Secretary Sylvia M. Burwell made the announcement during remarks Thursday as she kicked off what the agency described as "a two-day intensive convening of representatives from all 50 states and Washington, D.C. focused on preventing opioid overdose and opioid use disorder."

More than 16,000 people nationwide died from overdoses of prescription painkillers in 2013, and 145,000 over a decade. Pain pills contain synthetic opioids that mimic the effects of natural opiates like heroin. They also lead some users to move on to that far more dangerous and addictive drug; 8,000 people died from heroin overdoses in 2013, up 40 percent in a single year. (For an interactive graphic showing how the pattern of total drug deaths in the Philadelphia region has changed over 15 years, moving from city to suburb, click here.)

Burwell also announced $1.8 million in grants to rural communities in 13 states, including two in western Pennsylvania, to expand access to naloxone, an emergency medication that reverses an overdose by blocking opioid receptors in the brain.

"The opioid epidemic knows no boundaries; it touches lives in cities, rural counties and suburban neighborhoods across the country," Burwell said. "That's why it's so important that we come together – both state and federal leaders - and take a coordinated and comprehensive approach to address this crisis."

The two-day meeting was to discuss improving opioid prescribing practices, increasing access to naloxone, and expanding the use of medication-assisted treatment.

HHS released a report recently showing that 2.5 million people currently need treatment for opioid use disorder but fewer than 1 million are getting it. The change in regulations covering the prescribing of buprenorphine and products that contain it is intended to narrow that gap.

Currently, physicians that are certified to prescribe buprenorphine for opioid dependence are limited to 30 patients initially, and after one year can request authorization to write scripts for up to 100. The revision will be developed to provide a balance between expanding the supply of the therapy, encouraging use of proven medication-assisted treatments, and minimizing the risk of drug diversion, according to HHS.

"This is really a tremendous and long-awaited change in federal policy," Dr. Mark Publicker, past president of the Northern New England Society of Addiction Medicine, said in an interview with Maine Public Broadcasting. "Since buprenorphine came on the market in 2002, addiction medicine doctors have been in an impossible and absolutely unique situation of having to ration a life-saving medication."

Methadone – an older, better-known, and more widely used treatment – must be taken daily and often requires patients to pick it up from the clinic in person every day, although it also is more effective for some people.

Buprenorphine "can be done in an outpatient setting — you can get a prescription over the phone, you can get refills on it — it's an easier thing to do, just administratively for the physician," said Mary Dowd, a doctor in Portland, Maine.

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